Ambulatory Surgical Centers Payments

Provider Type

  • Participating Physician Groups (PPG)

Health Net considers payment claims for facility charges when the billing ambulatory surgical center (ASC) is licensed by the state of California, accredited by a recognized accreditation body, or certified by Medicare.

Participating physician group (PPG) coordinators and staff should notify ASCs that charges should be billed on a hospital form (UB-04). To document that it is a facility fee, a Medicare charge may be billed on a CMS-1500 with an SG modifier. If the Health Net Claims Department receives charges on any claim forms other than a UB-04 or a CMS-1500 for a Medicare charge for a facility fee, payment is delayed.

PPGs should verify whether the ASC contracts with Health Net. When the ASC contracts with Health Net, the facility charges are paid in accordance with the Provider Participation Agreement (PPA).